Current Developments in

Health Psychology
Univ.-Prof. Dr. Heather Foran
SS 2023
Aging and Dementia
Aging
• Huge increases in individuals over the age of 65 over the last century
• In Western Europe, shift from 13% in 1970 to 29% by 2050.
• Shift of focus from infectious diseases to chronic non-infectious diseases
• Now with COVID, shift to also recognize interactions between chronic diseases
and long-COVID, Covid-19
• Many normative age-related changes: hearing and vision changes, decreased lung
capacity, more difficulty with body temperature regulation, some declines in
cardiovascular functioning
• Some degree of cognitive decline is normative
• Unhealthy behaviors and lifestyles estimated to cause 50% of deaths in high-
income countries
• Exercise can reduce age-related declines in muscle mass and risk for physical
diseases
Aging
• Many normative age-related changes: hearing and vision changes,
decreased lung capacity, more difficulty with body temperature
regulation, some declines in cardiovascular functioning
• Some degree of cognitive decline is normative
• Unhealthy behaviors and lifestyles estimated to cause 50% of deaths
in high-income countries
• Exercise can reduce age-related declines in muscle mass and risk for
physical diseases
What is successful aging?
• In a review, 105 operational definitions were found with unique
models (Cosco et al. 2013)
• Most included physical health
• Half included activity levels (e.g., involvement in the community)
• Half included psychological well-being
• 25% included personal resources such as resilience
• 6% included other external factors such as finances.

• Consider these results in terms of the biopsychosocial model and

socioecological model….
Video shown in class
• https://www.hsph.harvard.edu/mair-lab/why-study-aging/
Psychosocial Factors in Health
• Research on psychosocial factors and aging:
• Early life psychosocial factors that influence health later in adulthood
• E.g., child trauma, obesity
• Psychosocial factors that influence health later in adulthood and health
promotion and rehabilitation
• E.g., loss of a spouse, family conflict
• E.g., attention to positive emotional experience (Socioemotional Selectivity theory)
• E.g., social networks
• Physical and mental health are strongly interrelated, but this association
weakens as one ages.
• Psychosocial factors that influence adaptation to illness later in adulthood
• E.g., motivational and control factors
Socioemotional Selectivity Theory (Carstensen, 1993; 2006)

• A developmental theory that suggest when individuals perceive they

have less time alive, they prioritize socioemotional well-being more.
• Younger people focus more on new experiences, new information,
long-term goals and achievement, whereas other people focus on
emotional satisfaction and meaning.
• The theory suggests older people are more satisfied and experience
more positive emotions.
• They attend to and remember more positive stimuli
• Called a “positivity effect” in cognitive processing.
• (Reed, Chan, & Mikels, 2014, meta-analysis of 100 studies)
Socioemotional Selectivity Theory (Carstensen, 1993; 2006)

• Measures: Future Time Perspective Scale, 10 items

• “Many opportunities await me in the future.” Very untrue to Very true
• “Most of my life lies ahead of me.” Very untrue to Very true
• Imagine you had half an hour of free time with no pressing time
commitments and had decided that you would spend this time with
another person, who would that person be?
• 1) family member
• 2) author of a book you just read
• 3) an acquaintance with whom you have a lot in common
Socioemotional Selectivity Theory (Carstensen, 1993; 2006)

• Imagine you had half an hour of free time with no pressing time
commitments and had decided that you would spend this time with
another person, who would that person be?
• 1) family member
• 2) author of a book you just read
• 3) an acquaintance with whom you have a lot in common

• Older adults choose 1 and younger adults had no preference (choose all 3 options).
(e.g., Fung et al., 2001; Fung et al., 1999)
• Results change in younger people if they are told they are going to move away or
older people if they are told that their life would be two decades longer.
• Elderly tend to reduce their social networks and focus on meaningful and close
relationships (Carstensen, Fung & Charles, 2003).
Social Network and Health
• Satisfying social networks can reduce mortality across different
diseases among elderly.
• Social ties are associated in longitudinal research over 7 years with
less declines in functioning (Unger et al., 1999)

• Thus, socioemotional selectivity may be adaptive.

Enhancing Group Engagement
• Elderly persons who are more socially active show better cognitive
functioning.
• Individual relationships are also important for health, but quality of
the relationship matters.
• The authors state “We no longer question the claim that social
relationships are vital for health”. (Haslam et al., 2014)
 Loneliness and Health
• Loneliness and social isolation show small correlations

• Loneliness is perceived isolation

• Social isolation is the number of social contacts and social
interactions
• Functional factors may be more important than structural
factors
• It is not marriage per se that is important, but marital
quality that is associated with better health

Sample recent study on this (see Table): Over 2200

respondents, data collected over 2 waves.

Published by Hawkley, Kocherginsky; 2017 Res Aging 40, 365-387.

DOI: 10.1177/0164027517698965
http://journals.sagepub.com/doi/figure/10.1177/0164027517698965?
 Loneliness measure

• 20 item original version (Russel, Peplau, & Cutrona, 1978)

• Sample items
• 1. I am unhappy doing so many things alone O S R N
• 2. I have nobody to talk to
• 3. I cannot tolerate being so alone
• 4. I lack companionship O S R N
• 5. I feel as if nobody really understands me
• 6. I find myself waiting for people to call or write
• 7. There is no one I can turn to
• 8. I am no longer close to anyone
• 9. My interests and ideas are not shared by those around me
Loneliness measure
• 3 item loneliness scale (Hughes et al. 2004).
The next questions are about how you feel about different aspects of your life. For each one, tell me how often you feel that
way.
Question Hardly Ever Some of the Time Often

First, how often do you

feel that you lack
companionship: Hardly 1 2 3
ever, some of the time,
or often?
How often do you feel
left out: Hardly ever,
1 2 3
some of the time, or
often?
How often do you feel
isolated from others?
1 2 3
(Is it hardly ever, some
of the time, or often?)
Influences of Social Control and Social
Support
• Social support is associated with health benefits among a variety of
patient populations
• Social support (and family environment) are associated with better
adherence to treatment (e.g., DiMatteo, 2004)

• Social control = efforts by social contact to increase health behaviors

and decrease unhealthy behaviors
• May backfire if patient perceives this as a loss of control
• Social contacts may be coercive, and if so, this is likely to be effective
 Global Challenge - Health Information
Communication
• Emotion-based advertising appears more effective in elderly than information-based due
to the positivity bias.
• This may be used by anti-aging marketing companies with products that are not effective
to exploit emotions, which has been condemned by some groups as unethical
• This bias is due to time limited perspective rather than aging per se.

• However, elderly people make health decisions based on less information and ask less
questions from their doctors. They are less likely to seek a second opinion. This can have
negative health consequences.
• They also have may have more difficulties with adherence to medical recommendations,
(e.g., medications).
• They are also more likely to refer decisions to their doctors or relatives.
• These differences may also be related to cognitive decline.
Goals in Aging Interventions
• Prevention of premature deaths due to modifiable risk factors
• Postponement of functional impairment and disability as long as
possible
• Preservation of independence and psychological well-being
(Rook et al., 2011).
Interventions may involve addressing loneliness, social isolation, loss,
mental and physical limitations, social networks, and family
relationships.
Interventions may also provide psychoeducation to support treatment
decisions for patients and their families
Dementia

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Dementia
• Most common among older adults
• Prevalence 1-5% of adults between 65 and 74
• Prevalence increases sharply with age, affects 15-80% of adults over 85 years old with
higher rates varying by country and representing increasing age (over 90)
• In Western Europe, 43% of adults over 90 (Prince et al., 2013)
• There are many subtypes of dementia

• https://www.youtube.com/watch?v=HobxLbPhrMc

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Dementia Overview
• Progression of Dementia: Initial Stages
• Memory impairment, visuospatial skills deficits
• Agnosia – Inability to recognize and name objects (most common symptom)
• Facial agnosia – Inability to recognize familiar faces
• Other symptoms – Delusions, depression, agitation, aggression, and apathy
• Progression of Dementia: Later Stages
• Cognitive functioning continues to deteriorate
• Person requires almost total support to carry out day-to-day activities
• Death results from inactivity combined with onset of other illnesses
DSM-5 Major & Minor Neurocognitive
Disorder
• Major
• Evidence of significant decline in cognitive functioning from previous level (complex
attention, executive functioning, learning, language, memory, perceptual motor, social
cognition)
• Interferes with independence in everyday activities
• Minor
• Evidence of a modest decline
• Does not interfere with capacity for independence in everyday activities

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DSM-5 Etiological subtypes
• Dementia of the Alzheimer’s type
• Vascular Dementia
• Dementia Due to Other General Medical Conditions or Substance
• Traumatic brain injury
• HIV infection
• Parkinson’s disease
• Huntington’s disease
• Due to multiple etiologies

• (There are several others)

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Dementia of the Alzheimer’s Type
• DSM-V Criteria
• Meet criteria for major or minor neurocognitive disorder
• Multiple cognitive deficits that develop gradually and steadily
• Impairment in memory, orientation, judgment, and reasoning
• Can include agitation, confusion, depression, anxiety, or combativeness
• May include evidence from genetic testing or family history

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Dementia of the Alzheimer’s Type
• Range of Cognitive Deficits
• Aphasia – Difficulty with language
• Apraxia – Impaired motor functioning
• Agnosia – Failure to recognize objects
• Difficulties with planning, organizing, sequencing, or abstracting information
• Impairments have a marked negative impact on social and occupational
functioning

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Dementia of the Alzheimer’s Type
• Nature and Progression of the Disease
• Deterioration is slow during the early and later stages, but rapid during
middle stages
• Average survival time is about 8 years
• Onset usually occurs in the 60s or 70s, but may occur earlier
• Most common subtype of dementia (60-90%)
• Risk factors include
• Low education, prior strokes, sedentary lifestyle, high body weight,
hypertension, and high cholesterol

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Causes of Alzheimer’s Disease
• Neurobiological Findings
• Neurofibrillary tangles – occur in brains of Alzheimer’s patients, nutrients are
able to move through the cells, cause cell death
• Protein deposits (Amyloid plaques) Accumulate excessively in brains of
Alzheimer’s patients
• Brains of Alzheimer’s patients tend to atrophy (de = veröden)
• Multiple genes involved (genetic testing can be used to test for known
mutations)
• Some new evidence that immune system functioning (chronic inflammation)
causes brain cells to die….may play a role for some dementias

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Vascular Dementia
• Progressive brain disorder caused by blockage or damage to blood
vessels
• Second leading cause of dementia next to Alzheimer’s
• Onset is often sudden (e.g., stroke)
• Patterns of impairment are variable, and most require formal care in
later stages
• DSM-V Criteria and Incidence
• Cognitive disturbances that are identical to dementia
• Neurological signs of brain tissue damage occur (documented via neuro-
imaging examination)

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Dementia Related to Human
Immunodeficiency Virus (HIV)
• HIV causes neurological impairments and dementia
• Cognitive slowness, impaired attention, and forgetfulness, clumsiness
• Repetitive movements (e.g., tremors/leg weakness), apathy, and social
withdrawal
• Progression of HIV-Related Cognitive Impairments
• Tend to occur during the later stages of HIV infection
• Impairments are observed in 29% to 87% of people with AIDS

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Other Dementias
• Head Trauma
• Accidents are leading causes of such cognitive impairments
• Memory loss is the most common symptom
• Parkinson’s Disease
• Degenerative brain disorder
• Dementia occurs during later stages, but not in all cases
• Affects 2-3% over 65 years old (Williams-Gray & Worth, 2016)
• Typical onset over 60, but early onset can occur
• Notable motor symptom impairment, such as shaking hands or legs
• Damage to dopamine pathways is believed to cause motor problems

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Other Dementias
• Huntington’s Disease
• Genetic autosomal dominant disorder (i.e., chromosome 4)
• Children of a parent with the disease has 50% chance of inheriting it
• 10% of cases may not be inherited but due to new mutation
• About 20% to 80% of persons go on to display dementia
• Other behavioral and emotional symptoms including anxiety, depressed mood,
irritability, and loss of interest
• Jerky, random or uncontrollable movements
• Similar across gender, age of onset 30-50 typically
• Substance-Induced Persisting Dementia
• Results from drug use in combination with poor diet
• Resulting brain damage may be permanent
• Dementia is similar to that of Alzheimer’s

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Psychosocial Factors in Dementia
• Do not cause dementia directly, but may influence onset and course
• Lifestyle factors – Drug use, diet, exercise, stress
• Cultural factors – Risk for certain diseases and accidents vary by ethnicity and
class
• Psychosocial factors – Educational attainment, coping skills, social support

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Family experiences with early-onset dementia
• Qualitative study of dyadic dynamics in couples with one partner who
has early onset dementia (Wawrziczny, et al. 2016)
• N =16 couples, 7 topics identified, examples..
• Protective behaviors: caregiving spouse in state of alert that patient will get
hurt, emotionally protective
• Disagreement about need for help: patients think they need less help or more
• Difficulty with role changes
• Controlling behaviors
• Troubled by being the “caregiver”, and almost taking on a parental role, not
feeling appreciated, less connection, feeling loss of the “couple”
Family experiences with early-onset dementia
(Wawrziczny, et al. 2016)
• Couple 15: Owing to the disease, I sense that he’s fragile, I sense that he’s threatened and it
makes me feel unsafe. [. . .] having a man next to you makes you more poised. And now I don’t
sense his presence anymore. He seems more fragile, more vulnerable. (Caregiver)
• Couple 02: I wasn’t seeing my husband as my husband anymore, this is not the same person
anymore. [. . .] There’s a side that has fallen apart. I said to myself ‘‘Oh no, I can’t count on him
anymore ...’’(Caregiver)
• Couple 02: We’ve lost all intimacy, we’ve lost all intimacy. At one point, there we were, side by
side. (Person with dementia)
• Couple 15: It can’t foster intimacy within the couple because it makes us both sad, it depresses
both of us. I mean, already we’re not young anymore, we don’t have hormones racing through us,
and if on top of that we’re concerned, worried, sad, we’re not going to be . . . obviously, how
could we? (Caregiver)
• Couple 04: From time to time, he mistakes me for his mom, so [. . .] couple. I wouldn’t say it’s
over but I do everything by myself [. . .] I’m often the only one talking and so it’s everything all
alone. Now there’s no more . . . I mean, it’s affection. There’s nothing left, it’s over. (Caregiver)
Treatment of Dementia
• May focus on cognitive symptoms (memory, language, attention) or
behavioral symptoms (agitation, depression, psychosis)
• 30-40% of patients with Alzheimer’s dementia show behavioral
symptoms in addition to cognitive symptoms
Treatment of Dementia
• Medications
• Few medical treatments exist for most types of dementia, emerging developing field
• Medications can slow progression of deterioration but do not stop the progression of
dementia
• May help with cognitive (acetylcholinesterase inhibitors; AChEI) and behavioral
symptoms (e.g., antipsychotics, antidepressants), but side effects need to be
considered, and more research is needed

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Treatment of Dementia
• Psychosocial Treatments
• Focus on enhancing the lives of dementia patients and their families/caregivers
• Teach adaptive skills
• Use memory enhancement devices (e.g., memory wallet)
• Main emphasis working with caregivers (caregiver stress is also an outcome)

• Evidence supportive of effects on behavioral symptoms and caregiver mental

health
• In the German guidelines for Dementia Treatment (“S3-Leitlinie Demenzen”)
• Some support for the following (albeit small effect): music therapy, exercise, cognitive
interventions, reminiscing groups
• Psychosocial interventions with caregivers/relatives have more support
Psychosocial Interventions with Caregivers
• Preparing for the future
• Early discussions with elderly parents about dementia
• Does not only apply for dementia, but for addressing aging with family
members to avoid future difficulties
• Providing psychoeducation and health care information to families and
patients
• Some programs have been tested including:
• Early Diagnosis Dyadic Intervention program (Whitlatch et al. 2006)
• Durcharme et al. 2011: RCT of intervention group and a control group, focused on
caregiver role and transition for relatives with Alzheimer disease
Future Directions and Global Challenges
• Required Reading:
• Obradovic, N. et al. (2018). Empirical evidence of mental health risks
posed by climate change. PNAS, 115, 10953-10958.
https://www.pnas.org/doi/epdf/10.1073/pnas.1801528115
WHO policy brief:
https://apps.who.int/iris/rest/bitstreams
/1422925/retrieve
Climate Change and Mental health risks
• Review of article as an example (e.g., Obradovic et al. 2018)
• Start with referencing prevalence of mental health problems – very
common
• Mental health problems worsen physical health and have economic
impacts
• Warming likely to increase natural disaster frequencies
• Which in turn has psychological and physical health consequences
• Natural disasters can be traumatic and linked with depressive and
PTSD
Climate Change and Mental health risks
• Data is available for replication:
https://dataverse.harvard.edu/dataset.xhtml?persistentId=doi:10.791
0/DVN/OVQY76
• Uses an epidemiological study measure of mental health from CDC
BRFSS study over 10 years from 2002 to 2012 (cross-sectional
samples)
• A large random sample, US adults, combined with meteorological
data
Climate Change and Mental health risks
• https://www.usnews.com/news/health-news/articles/2022-02-24/a-
hotter-climate-could-trigger-more-mental-health-crises

• https://jamanetwork.com/journals/jamapsychiatry/fullarticle/278948
1

• https://www.psychiatry.org/patients-families/climate-change-and-
mental-health-connections/affects-on-mental-health
From the WHO (June 3 2022)

https://www.who.int/news/item/03-06-2022-why-mental-
health-is-a-priority-for-action-on-climate-change
WHO policy recommendations
• “The new WHO policy brief recommends 5 important approaches for
governments to address the mental health impacts of climate change:
• integrate climate considerations with mental health programmes;
• integrate mental health support with climate action;
• build upon global commitments;
• develop community-based approaches to reduce vulnerabilities; and
• close the large funding gap that exists for mental health and psychosocial
support.”
• https://www.who.int/news/item/03-06-2022-why-mental-health-is-a-
priority-for-action-on-climate-change
• https://apps.who.int/iris/rest/bitstreams/1422925/retrieve
Health Communication Related to Global
Challenges (WHO policy brief example)

https://apps.who.int/iris/rest/bitstreams/1422925/retrieve
Thanks for your attention!